预防新生儿无创通气设备相关压力性损伤的最佳证据总结

doi:10.3761/j.issn.2096-7446.2024.12.007

摘要/Abstract

摘要： 目的全面检索、评价和总结新生儿无创通气设备相关压力性损伤预防的最佳证据。方法计算机检索国内外各大数据库、相关专业协会网站中关于新生儿无创通气设备相关压力性损伤预防的临床决策、最佳实践、指南、证据总结、专家共识、系统评价,检索时限为建库至2023年7月31日。结果共纳入文献9篇,包括临床决策1篇、指南3篇、证据总结2篇和专家共识3篇,从风险评估、营养管理、保持皮肤清洁及适宜的温湿度、敷料的正确使用、合理正确使用无创通气设备、多学科团队与教育培训6个方面共总结了21条最佳证据。结论该研究总结了预防新生儿无创通气设备相关压力性损伤的最佳证据,建议医务人员根据临床情景及新生儿的个体化差异有针对性地选择最佳证据并应用于临床,以降低新生儿无创通气设备相关压力性损伤的发生率,提升整体护理质量及家属满意度。

关键词: 婴儿, 新生, 无创通气, 压力性损伤, 循证护理学, 证据总结

Abstract: Objective To comprehensively search,evaluate and summarize the best evidences on the prevention of pressure injury related to noninvasive ventilation in neonates. Methods The clinical decisions,recommended practices,guidelines,evidence summaries,expert consensuses,and systematic evaluations on the prevention of pressure injury related to noninvasive ventilation of neonates in domestic and foreign databases and related professional websites were searched by computer. The retrieval time was from the establishment of database to July 31,2023. Results A total of 9 literature were included,including 1 clinical decision,3 guidelines,2 evidence summaries and 3 expert consensuses. A total of 21 pieces of best evidences were summarized from 6 aspects,including risk assessment,nutrition management,keeping skin clean and appropriate temperature and humidity,proper use of dressing,proper use of noninvasive ventilation equipment,multidisciplinary team and educational training. Conclusion This study summarized the best evidences for the prevention of pressure injury related to noninvasive ventilation in neonates. It is suggested that medical staff can select the best evidences according to the clinical situation and individualized differences of infants to reduce the incidence of pressure injuries related to noninvasive ventilation and improve the overall quality of nursing care and family satisfaction.

Key words: Infant, Newborn, Noninvasive Ventilation, Pressure Ulcer, Evidence-Based Nursing, Evidence Summary

孙兴, 李克华, 刘蓓蓓, 田莹莹, 徐微. 预防新生儿无创通气设备相关压力性损伤的最佳证据总结[J]. 中华急危重症护理杂志, 2024, 5(12): 1096-1103.

SUN Xing, LI Kehua, LIU Beibei, TIAN Yingying, XU Wei. Best evidence summary for prevention of pressure injury related to noninvasive ventilation in neonates[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(12): 1096-1103.

参考文献

[1] 万兴丽,李霞,胡艳玲,等. 重症监护病房新生儿皮肤管理指南(2021)[J]. 中国当代儿科杂志,2021,23(7):659-670.
Wan XL,Li X,Hu YL,et al.Guidelines for neonatal skin management in the neonatal intensive care unit(2021)[J]. Chin J Contemp Pediatr,2021,23(7):659-670.
[2] Stellar JJ,Hasbani NR,Kulik LA,et al.Medical device-related pressure injuries in infants and children[J]. J Wound Ostomy Continence Nurs,2020,47(5):459-469.
[3] August DL,Kandasamy Y,Ray R,et al.Fresh perspectives on hospital-acquired neonatal skin injury period prevalence from a multicenter study:length of stay,acuity,and incomplete course of antenatal steroids[J]. J Perinat Neonatal Nurs,2021,35(3):275-283.
[4] Boyar V.Pressure injuries of the nose and columella in pre-term neonates receiving noninvasive ventilation via a specialized nasal cannula:a retrospective comparison cohort study[J]. J Wound Ostomy Continence Nurs,2020,47(2):111-116.
[5] García-Molina P,Balaguer-López E,García-Fernández FP,et al.Pressure ulcers‘ incidence,preventive measures,and risk factors in neonatal intensive care and intermediate care units[J]. Int Wound J,2018,15(4):571-579.
[6] Apold J,Rydrych D.Preventing device-related pressure ulcers:using data to guide statewide change[J]. J Nurs Care Qual,2012,27(1):28-34.
[7] Berlowitz D. Prevention of pressure-induced skin and soft tissue injury[EB/OL]. (2022-01-10)[2023-04-14]. http://www.uptodate.cn/contents/prevention-of-pressure-induced-skin-and-soft-tissue-injury.
[8] National Pressure Ulcer Advisory Panel,European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers/injuries:clinical practice guideline[EB/OL]. (2019-11-15)[2023-04-14]. https://npiap.com/page/Guidelines.
[9] 新生儿医源性皮肤损伤的评估要点和预见性护理的专家共识工作组,海峡两岸医药卫生交流协会第一届新生儿专业委员会新生儿护理与护理管理学组. 新生儿医源性皮肤损伤的评估要点和预见性护理的专家共识[J]. 中国循证儿科杂志,2020, 15(3):161-165.
Expert Consensus Working Group on the Key Assessment Points of Iatrogenic Skin Injury and Predictive Care in Neonates,Neonatal Nursing and Nursing Management Group of the First Professional Committee of the Medical and Health Exchange Association of Both Sides of the Taiwan Straits. Key points of assessment of iatrogenic skin injury in neonates and expert consensus on predictive care[J]. Chin J Evid Based Pe-diatr,2020,15(3):161-165.
[10] Dicenso A,Bayley L,Haynes RB.Accessing pre-appraised evidence:fine-tuning the 5S model into a 6S model[J]. Evid Based Nurs,2009,12(4):99-101.
[11] 韦当,王聪尧,肖晓娟,等. 指南研究与评价(AGREE Ⅱ)工具实例解读[J]. 中国循证儿科杂志,2013,8(4):316-319.
Wei D,Wang CY,Xiao XJ,et al.Interpretation of the tools of AGREEⅡ[J]. Chin J Evid Based Pediatr,2013,8(4):316-319.
[12] The Joanna Briggs Institute. Checklist for text and opinion[EB/OL]. (2017-07-15)[2023-04-22]. https://jbi.global/sites/default/files/2021-10/Checklist_for_Text_and_Opinion.docx.
[13] Foster MJ,Shurtz S.Making the Critical Appraisal for Summaries of Evidence(CASE) for evidence-based medicine (EBM):critical appraisal of summaries of evidence[J]. J Med Libr Assoc,2013,101(3):192-198.
[14] Gefen A,Alves P,Ciprandi G,et al.Device-related pressure ulcers:secure prevention. Second edition[J]. J Wound Care,2022,31(Sup3a):S1-S72.
[15] World Union of Wound Healing Societies(WUWHS). Role of dressings in pressure ulcer prevention[EB/OL]. (2019-09-22)[2023-04-16]. https://woundsinternational.com/wp-content/uploads/sites/8/2023/02/1dd454a250ce4d00e5494e76e918df9b.pdf.
[16] 王春青,胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志,2015,30(11):964-967.
Wang CQ,Hu Y.JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train,2015,30(11):964-967.
[17] Munoz N,Litchford M,Cox J,et al.Malnutrition and pressure injury risk in vulnerable populations:application of the 2019 international clinical practice guideline[J]. Adv Skin Wound Care,2022,35(3):156-165.
[18] Norton L,Parslow N,Johnston D,et al. Best practice recommendation for the prevention and management of pressure Injuries[EB/OL]. (2021-02-11)[2023-04-16]. https://www.woundscanada.ca/docman/public/health-care-professional/bpr-workshop/172-bpr-prevention-and-management-of-pressure-injuries-2/file.
[19] Valdez F. Pressure injury prevention(pediatric):risk assessment[EB/OL]. (2022-06-07)[2023-04-16]. https://ovidsp-dc2-ovid-com.kean.idm.oclc.org/ovid-new-a/ovidweb.cgi?&S=KEILFPDNLMEBIMKGIPKJEHAFNNFHAA00&Link+Set=S.sh.21%7c1%7csl_190.
[20] Curley MAQ,Hasbani NR,Quigley SM,et al. Predicting pressure injury risk in pediatric patients:the braden QD scale[J]. J Pediatr,2018,192:189-195.e2.
[21] Moore ZE,Patton D. Risk assessment tools for the prevention of pressure ulcers[J]. Cochrane Database Syst Rev,2019,1(1):CD006471.
[22] Mervis JS,Phillips TJ.Pressure ulcers:prevention and management[J]. J Am Acad Dermatol,2019,81(4):893-902.
[23] 李语薇. 新生儿营养风险筛查工具的构建与临床应用研究[D]. 重庆:重庆医科大学,2017.
Li YW.A study of development and clinial application for a nutritional risk screening tool in neonates[D]. Chongqing:Chong-qing Medical University,2017.
[24] Kurimoto T,Ibara S,Ishihara C,et al.Incubator humidity and temperature control in infants born at 22-23 weeks‘ gestation[J]. Early Hum Dev,2022,166:105550.
[25] Rezaei P,Jafari-Mianaei S,Sadeghnia A,et al.Protective dres-sings,injury,and device failure in preterm infants receiving nasal continuous positive airway pressure:a randomized controlled trial[J]. Adv Skin Wound Care,2021,34(9):1-6.
[26] 朱倩,佟丹阳,张鹏宇,等. 无创通气设备不同连接方式对NICU患儿鼻部压力性损伤的网状Meta分析[J]. 护理学杂志,2023,38(22):52-57.
Zhu Q,Tong DY,Zhang PY,et al.Nasal pressure injury in children in NICU by different non-invasive ventilation device connections:a network meta-analysis[J]. J Nurs Sci,2023,38(22):52-57.
[27] 朱凤,林婷,丁文雯,等. NCPAP早产儿鼻塞与鼻罩交替间隔时间的研究[J]. 护理学杂志,2023,38(13):43-46.
Zhu F,Lin T,Ding WW,et al.Study on length of rotation of nasal prongs and nasal mask in premature infants undergoing nasal continuous positive airway pressure[J]. J Nurs Sci,2023,38(13):43-46.
[28] 刘晓黎,王泠,王志稳,等. 无创通气设备相关面部压力性损伤预防的证据总结[J]. 中国护理管理,2019,19(10):1532-1537.
Liu XL,Wang L,Wang ZW,et al.Evidence summary of prevention of Noninvasive Ventilation related facial Pressure Injuries[J]. Chin Nurs Manag,2019,19(10):1532-1537.
[29] Tan JJM,Cheng MTM,Hassan NB,et al.Nurses‘ perception and experiences towards medical device-related pressure injuries:a qualitative study[J]. J Clin Nurs,2020,29(13/14):2455-2465.
[30] Keys E,Luctkar-Flude M,Tyerman J,et al.Developing a virtual simulation game for nursing resuscitation education[J]. Clin Simul Nurs,2020,39:51-54.